Basic Information
| Provider Information | |||||||||
| NPI: | 1225053267 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FERRUCCI | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16111 PLUMMER ST # 112E | ||||||||
| Address2: | |||||||||
| City: | SEPULVEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913432036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188917711 | ||||||||
| FaxNumber: | 8188959597 | ||||||||
| Practice Location | |||||||||
| Address1: | 16111 PLUMMER ST # 112E | ||||||||
| Address2: | |||||||||
| City: | SEPULVEDA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913432036 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8188917711 | ||||||||
| FaxNumber: | 8188959597 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 10759T | CA | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 2208 | TN | N | Eye and Vision Services Providers | Optometrist |
No ID Information.